NAME: ..................................................................................................................... QUESTION 1: Dispensing and Labelling Marks 20 Please prepare and label the medication of the following prescription you have written: Mr L Pain Ref: 23/05 18 Kiewiet Street Rooihuiskraal 0012 1. Nux vomica 200cH Mitte: 30mL amber glass bottle (agb) 20% R-OH Sig. Take 10-15 drops three times a day fro seven days for dyspepsia 2. Ribes nigrum Mitte: 50mL agb Sig. Take 15 drops three times a day for inflammation (10) Label 1 (5) Label 2 (5) Marks 10 NAME: ..................................................................................................................... QUESTION 2: Counselling (Role play): 1. Mrs Penelope Smith has a sore throat . The following medication has been prescribed and dispensed for her. You must now counsel her on the usage thereof: 1. Apis mel 200cH Mitte: 6 powders Sig. 1 powder every thirty minutes 2. Calendula Ǿ Mitte: 30ml agb Sign. Put 5ml into 30ml distilled water. Gargle for 30 seconds. Repeat every 2-3 hours for 48 hours (5) 2. Mrs C Shabalala has a wart on her left hand. The following medication has been prescribed and dispensed for her. You must now counsel her on the usage thereof: 1. Thuja Cream 4% v/m (W LAST) Sign: Apply to affected area three times daily (5) IMPORTANT!! No matter what is written on the script always double check the age of the patient and see that prescribed substances are appropriate for infants, elderly, diabetics, religious groups, alcoholics and ALWAYS check if a women is pregnant or may be pregnant!! NAME: ..................................................................................................................... Marks 10 QUESTION 3: Procurement and storage Write short notes on receiving incoming stock. 5. Receiving Incoming Stock Must be received in person; this will allow mistakes to be spotted early. The stock must also be accompanied by the necessary delivery documentation Check delivery Is the correct practice address an each container Are the number of containers correct Check containers for intactness and tampering Deal with cold chain items first, if it was not cold packed, do not except Check Vaccine Vial Monitors (VVM) – if discoloured do not except Is there any discoloration of any liquids Are there any unsealed or unlabelled items Schedule 5 & 6 items must be entered into the relevant registers and stored in a dedicated facility Signature, date & time plus official stamp on delivery note NAME: ..................................................................................................................... Marks 10 QUESTION 4: Dispensing Records and Registers 1. Which information are you legally required to enter into a Schedule 6 register (4) Date of receipt of From where Quantity Reference number Given to whom How much Date Script reference number Prescriber 2. Which information are you legally required to enter into a prescription record book Name of active ingredient Dosage form and quantity Complete instructions / storage conditions / eg. cool dry place Name of patient Date of prescription Dispenser (2½) NAME: ..................................................................................................................... Marks 10 QUESTION 6: PIL Write a patient information leaflet for the use of Hypericum perforatum Ǿ in a mildly depressed patient. This PIL should adhere to the principles of lay language to inform the patient. Use the reference material provided at this station. Name: If using trade product(1) Contents: (1) Dosage form: Drops (1) What used for: Mild depression (1) Direction / How used: 10 drops three times daily(1) When not to use: When on any antidepressant drugs(1) Other effects: None known. (1) Warnings: Discontinue if any signs of sensitivity develop. Do not use during pregnancy and lactation. Safety in children not established (1) May interact with other drugs: May affect the efficacy of the contraceptive pill. Other antidepressant drugs (1) Manufacturer (1) Date of PIL (1) NAME: ..................................................................................................................... Marks 10 QUESTION 7: DRUG-DRUG INTERACTION It is essential that a practitioner using tinctures and low potencies must ensure that they educate themselves on possible drug-drug interactions Review the following prescription and discuss possible drug-drug interactions. Also change the script to better suit the patient’s needs. Mr P Ramathuba, a 55 year old patient , is treated with warfarin (5 mg/d) for his heart valve lesion and metformin (glucophage 500 mg twice daily) for type 2 diabetes mellitus. He has just had a bad fall an bruised his left buttock. You want to prescribe Arnica montana Ǿ 15 drops three times a day for seven days. (a) Which of these drugs may interact and how? Arnica montana has an anti-coagulant action and may enhance the effect of the warfarin (b) What will be the result of the interaction? The patient may develop minor or major haemorrhage by increasing bleeding tendency (c) How can you change this script (which new drug?) without putting him at risk? Motivate. Arnica montana should be given in a higher potency to eliminate anticoagulant effect. NAME: ..................................................................................................................... Marks 10 QUESTION 8: ETHICAL ISSUES After evaluation of the following case study answer the questions below from the perspective of a dispenser. Note all answers should be clearly motivated. Sheila, a divorced mother of Sipho (10 years) comes to see you and hands you a script from her general practitioner on which the following information was written. (a) Diagnosis of disease – asthma with acute sinusitis. (b) (i) Medicines: Salbutamol inhaler 2 puffs as needed to relieve chest tightness maximum 4 times / day (ii) Budesonide inhaler (100 µg) 2 puffs twice daily – use spacer device. (iii) Amoxycillin 250 mg po three times per day for 5 days The mother only wants the prescribed allopathic medicines as she informs you that she prefers homoeopathic medicines for her childs asthma and purulent sinusitis. 1. How would you advise the mother? (3) Explain the treatment options and risks. Counsel about the disease / acute exacerbation / hospitalisation / dangers etc. Explain the benefit of the prescribed allopathic medication 2. If after examination you are concerned that the child has developed meningitis. If the mother still absolutely refuses to consider the allopathic treatment. Should you inform the father of the child if the mother still refuses treatment? (3) After counselling the mother should be asked to do this If she refuses the best interest of the child should be looked at After instruction you may inform the mother that you may get legal assistance (court order) to Tell the father as her refusal may gravely affect the outcome of the disease Insist that the mother sign an indemnity form 3. Has the father any rights since they are now divorced? (2) Yes, According to law both parents must consent to treatment If they do not agree the child’s best interest should be taken into account 4. What about assent from the child? It is always better to get assent from children when they can understand as this improves compliance and disease outcome. From 10-12 years on this should be the norm (2) NAME: ..................................................................................................................... Marks 10 QUESTION 9: SCRIPT WRITING Write a script adhering to all legal requirements for the following patient. Mr Reginald Ramathuba, 68 years lives in 6 Long Street Cape Town. He belongs to the Bonitas Medical Scheme , member number X17783. He is a hypertension sufferer but are otherwise healthy. You have decided on Remedy RRR 6X in the mornings for one month. Note you are the prescriber at your clinic/rooms. You want to prescribed 50mL of Remedy RRR in 20% alcohol. Drs Name Surname, Qualification (University) Address Contact numbers Practice number Emergency contact number Name and address of patient Sex and age Medical aid Date (1) Hours of practice (1) (3) (1) Diagnosis ( ICD 10 Code 1) Rx : Full Name of Remedy (in latin) and potency Mitte: 50mL agb 20% R-OH Sign: Place 15 drops under the tongue every morning for 30 days (2) Signature (2) Qualification if not mentioned on top